Split-belt adaptation and gait symmetry in transtibial amputees walking with a hybrid EMG controlled ankle-foot prosthesis

Our ability to automatically adapt our walking pattern to the demands of our environment is central to maintaining a steady gait. Accordingly, a large effort is being made to extend and integrate this adaptability to lower-limb prostheses. To date, the main focus of this research has been on short term adaptation, such as in response to a terrain transition or a sudden change in the environment. However, long term adaptation and underlying sensorimotor learning processes are critical to optimizing walking patterns and predictively changing our gait when faced with continued perturbations. Furthermore, investigating these processes in lower-limb amputees may provide a unique window into the interplay between sensory driven adaptation and top-down cerebellar modulation of locomotor reflexes and may potentially help alleviate gait asymmetries. In the current exploratory study, we therefore investigated adaptation, sensorimotor learning, and gait symmetry in a group of transtibial amputees walking with a hybrid-EMG controlled powered prosthesis and matched controls (both groups N=3). Participants were asked to perform a split-belt walking trial during which the belt on the affected side ran at twice the speed of the contralateral belt (1.0m/s and 0.5m/s respectively). Adaptation, sensorimotor learning, and symmetry are compared to two baseline conditions. Initial results illustrate that the amputees were readily able to use the hybrid controller, modulated their EMG depending on treadmill speed, and successfully adapted their gait during split-belt walking. However, the temporal gait parameters suggest that amputees used a different adaptation technique and showed reduced sensorimotor learning, while gait symmetry was improved, in the short term, post-adaptation

University students’ experiences of recreational class a drug taking and perspectives on personal, social and health education (PSHE) drug education

Purpose: Research suggests that student drug use is substantially higher than that of the general population and while the UK Government’s current Drug Strategy emphasises the importance of PSHE in preventing young people from becoming drug users, there is a lack of research investigating the longer-term effectiveness of drug prevention education, and students’ views using qualitative methods. The purpose of this paper is to gain a holistic understanding into university students’ lived experiences of recreational class A drug taking and the drug education taught in English secondary schools. Design/methodology/approach: Five interviews with university students were undertaken and thematically analysed using an ideographic case study approach alongside a qualitative content analysis of publicly available drug education resources and policy documents. Findings: The normalisation of drug taking at university and social micro-pressures to assimilate group norms were key contributing factors to participants’ drug use. While the content of drug education in PSHE is grounded in theory, its implementation is not. Originality/value: This study extends upon existing theories of normalisation of drug use at university through the concept of micro-pressures to offer an explanation of the process by which students assimilate group norms through the implicit threat of not fitting in

The contribution of staff call light response time to fall and injurious fall rates: an exploratory study in four US hospitals using archived hospital data

Abstract Background Fall prevention programs for hospitalized patients have had limited success, and the effect of programs on decreasing total falls and fall-related injuries is still inconclusive. This exploratory multi-hospital study examined the unique contribution of call light response time to predicting total fall rates and injurious fall rates in inpatient acute care settings. The conceptual model was based on Donabedian's framework of structure, process, and health-care outcomes. The covariates included the hospital, unit type, total nursing hours per patient-day (HPPDs), percentage of the total nursing HPPDs supplied by registered nurses, percentage of patients aged 65 years or older, average case mix index, percentage of patients with altered mental status, percentage of patients with hearing problems, and call light use rate per patient-day. Methods We analyzed data from 28 units from 4 Michigan hospitals, using archived data and chart reviews from January 2004 to May 2009. The patient care unit-month, defined as data aggregated by month for each patient care unit, was the unit of analysis (N = 1063). Hierarchical multiple regression analyses were used. Results Faster call light response time was associated with lower total fall and injurious fall rates. Units with a higher call light use rate had lower total fall and injurious fall rates. A higher percentage of productive nursing hours provided by registered nurses was associated with lower total fall and injurious fall rates. A higher percentage of patients with altered mental status was associated with a higher total fall rate but not a higher injurious fall rate. Units with a higher percentage of patients aged 65 years or older had lower injurious fall rates. Conclusions Faster call light response time appeared to contribute to lower total fall and injurious fall rates, after controlling for the covariates. For practical relevance, hospital and nursing executives should consider strategizing fall and injurious fall prevention efforts by aiming for a decrease in staff response time to call lights. Monitoring call light response time on a regular basis is recommended and could be incorporated into evidence-based practice guidelines for fall prevention.http://deepblue.lib.umich.edu/bitstream/2027.42/112579/1/12913_2011_Article_2004.pd

The personal experience of parenting a child with Juvenile Huntington’s Disease: perceptions across Europe

The study reported here presents a detailed description of what it is like to parent a child with juvenile Huntington’s disease in families across four European countries. Its primary aim was to develop and extend findings from a previous UK study. The study recruited parents from four European countries: Holland, Italy, Poland and Sweden,. A secondary aim was to see the extent to which the findings from the UK study were repeated across Europe and the degree of commonality or divergence across the different countries. Fourteen parents who were the primary caregiver took part in a semistructured interview. These were analyzed using an established qualitative methodology, interpretative phenomenological analysis. Five analytic themes were derived from the analysis: the early signs of something wrong; parental understanding of juvenile Huntington’s disease; living with the disease; other people’s knowledge and understanding; and need for support. These are discussed in light of the considerable convergence between the experiences of families in the United Kingdom and elsewhere in Europe

Combining GPS, GIS, and Accelerometry: Methodological Issues in the Assessment of Location and Intensity of Travel Behaviors

Background: Global positioning systems (GPS), geographic information systems (GIS), and accelerometers are powerful tools to explain activity within a built environment, yet little integration of these tools has taken place. This study aimed to assess the feasibility of combining GPS, GIS, and accelerometry to understand transport-related physical activity (TPA) in adults. Methods: Forty adults wore an accelerometer and portable GPS unit over 7 consecutive days and completed a demographics questionnaire and 7-day travel log. Accelerometer and GPS data were extracted for commutes to/from workplace and integrated into a GIS database. GIS maps were generated to visually explore physical activity intensity, GPS speeds and routes traveled. Results: GPS, accelerometer, and survey data were collected for 37 participants. Loss of GPS data was substantial due to a range of methodological issues, such as low battery life, signal drop out, and participant noncompliance. Nonetheless, greater travel distances and significantly higher speeds were observed for motorized trips when compared with TPA. Conclusions: Pragmatic issues of using GPS monitoring to understand TPA behaviors and methodological recommendations for future research were identified. Although methodologically challenging, the combination of GPS monitoring, accelerometry and GIS technologies holds promise for understanding TPA within the built environment

Kids in the city study: research design and methodology

Background: Physical activity is essential for optimal physical and psychological health but substantial declines in children's activity levels have occurred in New Zealand and internationally. Children's independent mobility (i.e., outdoor play and traveling to destinations unsupervised), an integral component of physical activity in childhood, has also declined radically in recent decades. Safety-conscious parenting practices, car reliance and auto-centric urban design have converged to produce children living increasingly sedentary lives. This research investigates how urban neighborhood environments can support or enable or restrict children's independent mobility, thereby influencing physical activity accumulation and participation in daily life.Methods/Design: The study is located in six Auckland, New Zealand neighborhoods, diverse in terms of urban design attributes, particularly residential density. Participants comprise 160 children aged 9-11 years and their parents/caregivers. Objective measures (global positioning systems, accelerometers, geographical information systems, observational audits) assessed children's independent mobility and physical activity, neighborhood infrastructure, and streetscape attributes. Parent and child neighborhood perceptions and experiences were assessed using qualitative research methods.Discussion: This study is one of the first internationally to examine the association of specific urban design attributes with child independent mobility. Using robust, appropriate, and best practice objective measures, this study provides robust epidemiological information regarding the relationships between the built environment and health outcomes for this population

A Novel Genome-Wide Association Study Approach Using Genotyping by Exome Sequencing Leads to the Identification of a Primary Open Angle Glaucoma Associated Inversion Disrupting ADAMTS17

Closed breeding populations in the dog in conjunction with advances in gene mapping and sequencing techniques facilitate mapping of autosomal recessive diseases and identification of novel disease-causing variants, often using unorthodox experimental designs. In our investigation we demonstrate successful mapping of the locus for primary open angle glaucoma in the Petit Basset Griffon Vendéen dog breed with 12 cases and 12 controls, using a novel genotyping by exome sequencing approach. The resulting genome-wide association signal was followed up by genome sequencing of an individual case, leading to the identification of an inversion with a breakpoint disrupting the ADAMTS17 gene. Genotyping of additional controls and expression analysis provide strong evidence that the inversion is disease causing. Evidence of cryptic splicing resulting in novel exon transcription as a consequence of the inversion in ADAMTS17 is identified through RNAseq experiments. This investigation demonstrates how a novel genotyping by exome sequencing approach can be used to map an autosomal recessive disorder in the dog, with the use of genome sequencing to facilitate identification of a disease-associated variant

ReseArch with Patient and Public invOlvement: a RealisT evaluation - the RAPPORT study

Background Patient and public involvement (PPI) is a prerequisite for many funding bodies and NHS research ethics approval. PPI in research is defined as research carried out with or by the public rather than to, about or for them. While the benefits of PPI have been widely discussed, there is a lack of evidence on the impact and outcomes of PPI in research. Objectives To determine the types of PPI in funded research, describe key processes, analyse the contextual and temporal dynamics of PPI and explore the experience of PPI in research for all those involved. Mechanisms contributing to the routine incorporation of PPI in the research process were assessed, the impact of PPI on research processes and outcomes evaluated, and barriers and enablers to effective PPI identified. Design A three-staged realist evaluation drawing on Normalisation Process Theory to understand how far PPI was embedded within health-care research in six areas: diabetes mellitus, arthritis, cystic fibrosis, dementia, public health and learning disabilities. The first two stages comprised a scoping exercise and online survey to chief investigators to assess current PPI activity. The third stage consisted of case studies tracked over 18 months through interviews and document analysis. The research was conducted in four regions of England. Participants Non-commercial studies currently running or completed within the previous 2 years eligible for adoption on the UK Clinical Research Network portfolio. A total of 129 case study participants included researchers and PPI representatives from 22 research studies, and representatives from funding bodies and PPI networks

Evolutionary Toggling of Vpx/Vpr Specificity Results in Divergent Recognition of the Restriction Factor SAMHD1

SAMHD1 is a host restriction factor that blocks the ability of lentiviruses such as HIV-1 to undergo reverse transcription in myeloid cells and resting T-cells. This restriction is alleviated by expression of the lentiviral accessory proteins Vpx and Vpr (Vpx/Vpr), which target SAMHD1 for proteasome-mediated degradation. However, the precise determinants within SAMHD1 for recognition by Vpx/Vpr remain unclear. Here we show that evolution of Vpx/Vpr in primate lentiviruses has caused the interface between SAMHD1 and Vpx/Vpr to alter during primate lentiviral evolution. Using multiple HIV-2 and SIV Vpx proteins, we show that Vpx from the HIV-2 and SIVmac lineage, but not Vpx from the SIVmnd2 and SIVrcm lineage, require the C-terminus of SAMHD1 for interaction, ubiquitylation, and degradation. On the other hand, the N-terminus of SAMHD1 governs interactions with Vpx from SIVmnd2 and SIVrcm, but has little effect on Vpx from HIV-2 and SIVmac. Furthermore, we show here that this difference in SAMHD1 recognition is evolutionarily dynamic, with the importance of the N- and C-terminus for interaction of SAMHD1 with Vpx and Vpr toggling during lentiviral evolution. We present a model to explain how the head-to-tail conformation of SAMHD1 proteins favors toggling of the interaction sites by Vpx/Vpr during this virus-host arms race. Such drastic functional divergence within a lentiviral protein highlights a novel plasticity in the evolutionary dynamics of viral antagonists for restriction factors during lentiviral adaptation to its hosts. © 2013 Fregoso et al